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Rule Changes Address Contraceptive Devices

Texas women who receive state-financed health servicesmay be able to more easily access contraceptive products like intrauterine devices and hormonal implants beginning Friday, when rule changes to the state’s Medicaid program and the Texas Women’s Health Programtake effect.

Under the new rules implemented by the state’s Health and Human Services Commission, physicians who participate in the two programs will be able to order long-acting reversible contraception (LARC) products from three pharmacies in Texas instead of having to purchase them from a drug wholesaler. The state is hoping this will increase the number of physicians who offer the products because they will no longer incur out-of-pocket costs to obtain them. Instead, the pharmacies will be required to bill the state’s programs to cover the costs of the LARC products.

“[Physicians] will now be able to access these products as needed without having to stock or pay for them up front, which can be costly for them because these products are fairly expensive,” said Linda Edwards Gockel, a spokeswoman for the Health and Human Services Commission.

The new rules will also allow physicians to return unused and unopened LARC products through a “buyback” program — an option that state officials anticipate will encourage more doctors to offer the products and ultimately increase access for women seeking the devices.

LARC products have been available through the state programs — which serve hundreds of thousands of Texas women — for years, but many participating doctors don’t offer them because of low reimbursement rates from the state after having to purchase the devices. Other doctors are left with unused, expensive products if the women they were prescribed for change their minds.

Despite the rule changes, some OBGYNs are apprehensive of how successful the new prescription process will be because they say they have not received enough information from the state about it.

“This is a step in the right direction until we know all the details,” said Dr. Tony Dunn, a Waco OBGYN and steering committee chairman for the Texas Women’s Healthcare Coalition, a group of more than 30 medical trade associations and community-based organizations that promote access to preventive care.

The LARC products will only be available to women’s health providers through three specialty pharmacies in Houston, Fort Worth and Frisco, and they can be delivered by mail to individual doctors’ offices.

But Dunn said physicians who participate in the state programs have yet to receive specifics on how to order the products or how long they will be required to hold on to them before they can use the “buyback” program.

He also said that the changes to the programs’ rules come at a time when state lawmakers are considering consolidating the state’s various programs that primarily provide health services to poor women, including the Texas Women’s Health Program.

“I don’t know how much of an improvement this will be or if it’s going to exchange some headaches for other headaches,” said Dunn, who is also the vice chairman of the Texas arm of the American Congress of Obstetricians and Gynecologists.

A recent report by the Texas Policy Evaluation Project (TxPEP) at the University of Texas at Austin — which is studying the effects of reproductive health-related laws passed during the last two legislative sessions — found that the LARC products are popular among Texas women.

Nearly 75 percent of women surveyed by the TxPEP said their preferred form of birth control during the postpartum period would be an intrauterine device, a contraceptive implant or sterilization. But only 27 percent of those women were using those methods six months after giving birth, according to the report.

The number of claims for LARC products through the Women’s Health Program dropped from 5,395 in 2012 to 4,502 in 2013, when roughly 40 Planned Parenthood clinics were excluded from the state-financed program.

State officials relaunched the program in 2013 after the federal government discontinued its $9-to-$1 match for the program — a move prompted by the Republican-led Legislature’s decision to keep health providers that were in any way affiliated with abortion providers, primarily Planned Parenthood, from receiving state tax dollars. (By law, none of the providers in the program performed abortions.)

The state-run program has struggled to fill the gap left by the exclusion of Planned Parenthood clinics, which provided 40 percent of Women’s Health Program services in 2012.

Dr. Kristine Hopkins, co-investigator for TxPEP, applauded the state’s rule change as a way to help improve access, and she suggested that the move could be part of new strategies the state has had to develop to find providers to fill the gap.

“I am hopeful that this is a helpful step in the new constellation of services that has excluded Planned Parenthood … from the state-funded services,” Hopkins said.

This story was produced in partnership withKaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

Disclosure: The University of Texas at Austin is a corporate sponsor of The Texas Tribune. A complete list of Texas Tribune donors and sponsors can be viewed here.